Soft tissue augmentation of the face has gained popularity due to the use of a wide diversity of injectable fillers. From synthetic materials to fat, any soft tissue zone of the face can be injected. While facial implants have been around for many years for hard tissue augmentation, such as the chin, cheeks and jaw angles, there are many more soft tissue zones than there are hard tissue ones.

One of the facial soft tissue zones that has become possible to reliably treat is that of the temples. The temporal zone is very much like the submalar-lateral facial zone in that it is a ‘trampoline’ facial zone. It is surrounded by bony margins that support skin and underlying fat and muscle. The superior margin is the anterior temporal line, the transition area into the bony forehead. Its anterior margin is the lateral orbital wall and its inferior border is the zygomatic arch. Its posterior border is not significant in most cases because it is obscured by the hairline and temporal scalp.

The contour shape of the temples is primarily influenced by how much fat and muscle lies underneath. Skin laxity is not an issue. Most commonly there is a slight concavity to the temples. But too much concavity or even excessive convexity is obvious and disrupts the shape of the overall face. How much temporal concavity is aesthetically acceptable is a matter of debate and belies any known established measurements. But when excessive the bony margins become obvious and presents an appearance of aging or even illness.

I have observed that placing a ruler or straight instrument between the anterior temporal line and the zygomatic arch, most people will have 1 to 3mms of concavity at the central or deepest area of the temples. When it exceeds 5mms or more, most people would view it as excessive temporal concavity.

For temporal hollowing, the most common treatments to date are injectable fillers. Treatment options include hyaluronic acid, PLLA and HA fillers as well as fat injections. Most of these injectable fillers are placed in the subcutaneous space between the skin and the superficial temporalis fascia. While this is where the frontal branch of the facial nerve passes, the risk of injury is low. Some do place fillers directly under the fascia into the temporalis muscle but this is less commonly done. In theory the muscle is a better place for longevity of fillers, particularly that of fat, but the push on the skin from under the temporalis fascia is weakly transmitted because the stiffer fascia pushes back against the soft filler.

While injectable fillers can be effective for temporal hollowing, they are not permanent and the volume needed for a single treatment is costly. It usually takes 2ccs of filler per side to have a visible effect. An alternative treatment for temporal hollowing is that of a synthetic implant. Made out of a flexible and very soft silicone material, temporal implants are inserted under the deep temporal fascia. It produces a result that is more significant that any injectable filler treatment and will create a permanent augmentation.

The surgical technique for placement of a temporal implant is very simple and can be done under local anesthesia if desired. Through a small vertical incision in the temporal hairline, the deep fascia is incised and the pocket quickly and easily made. Different sizes of temporal implants exist depending upon the depth of the concavity and the use of preoperative sizers. Adjustments to implant size can be easily done by trimming with scissors. There is no need for implant fixation as the pocket on top of the muscle controls its position. There is minimal discomfort afterwards and no bruising. The swelling is mild and there is no discomfort on chewing.

The simplicity and the permanence of specific shapes of synthetic implants should be considered as an option for the treatment of aesthetic temporal hollowing.  

Dr. Barry Eppley

Indianapolis, Indiana   

Many injectable fillers used for cosmetic facial augmentation are composed of the substance known as hyaluranon or hyaluronic acid. While it is synthetically produced, it is a natural substance found through the body. Known as a glycosaminoglycan or GAG, it is a complex carbohydrate or sugar that is essential for life. Its recognized molecular structure and its ability to attract water is what it makes an excellent filling substance that causes few reactivity problems. Its affinity for water absorption is also why it eventually breaks down and is absorbed naturally.

Injectable fillers have come a long way since the approval of the first non-collagen based product in 2002. While once conceived as only a way to make lips bigger and nasolabial folds less deep, injectable fillers have evolved into an aesthetic technology that has a wide number of facial uses. Aiding the expanded uses has been helped by the large number of different filler compositions offering variability in viscosity and flow charactistics as well as in longevity and in how they create their effects.

Fundamentally, injectable fillers are used for two main aesthetic applications, spot filling and volumetric enhancement. It is the latter that is often coined as ‘non-surgical facial sculpting’. That term is probably more accurate than not as it definitely takes skill and a good eye to get pleasing facial volume results with fillers. There is more art to it than science.

When it comes to facial volumetric enhancement with fillers, they are often compared to and even viewed as a substitute for surgical solutions to the same problems. Some injectors view synthetic fillers as  a better treatment choice as they are easier to do and have less risk of complications than surgery. While that is true, that does not mean they always give better aesthetic results or offer the best value for the money invested to do them.  There are advantages and disadvantages with both approaches depending upon exactly what facial application to which one is referring.

For skeletal augmentation of the three facial highlights, chin, cheek and jaw angles, injectable fillers can be used to create a visible external effect. When placed down at the bone level, I prefer Radiesse. Its calcium hydroxyapatite composition makes it the most viscous filler which provides a better push of the overlying soft tissues per cc of volume.  But when comparing it to synthetic facial implants that have been used for decades, it has several disadvantages. It takes a fair amount of syringe volume to get a visible effect, often at least two or three syringes depending upon the area. (chin = 1 syringe, cheeks = 2 syringes, jaw angle angles = 3 to 4 syringes) This makes it relatively expensive. In addition, the effect will never be as significant as a surgical implant and the filler material will go away by about one year or so after injection. This makes using an injectable filler for facial skeletal augmentation very patient selective. Filler are best used for skeletal augmentation when one is uncertain about how a surgical implant may look (trial ‘implant’) or if the need/result is time dependent based on an upcoming event and one doesn’t want to recover from surgery.

Other injectable fillers can be used for a skeletal effect but are placed in the subcutaneous tissues and not down at the bone level. In these cases, a hyaluron-based filler like Juvederm or Perlane are preferred which have higher material concentrations and will last about a year also.

The face is made up of a lot of non-skeletal areas that are not supported by underlying bone. These include two large areas in the lateral face and the temples. In the triangular area between the cheeks, chin and jaw angles lies the lateral facial region whose shape is not dependent on any bony support. It can be concave, flat or convex depending upon the shape of one’s face and the thickness of the underlying soft  tissues. This area has garnered a lot of attention in facial aging as it becomes more concave in some people as they age due to fat atrophy. Plumping it up with fillers has become popular as a rejuvenative manuever. I prefer Sculptra for the lateral facial triangle because of the volume of material needed. Using an 8cc per bottle reconstitution of Sculptra creates an almost pure watery form. This makes it  easy to get a good amount of material over this large area and have a low risk of creating any lumps. Sculptra does not work immediately and it takes time and three total injection sessions to get the best result. But it will last for up to two years.

The temple area is another soft tissue supported area. Muscle and fat make up its shape and it is smaller than the lateral facial triangle but still has a sizeable surface area. Sculptra seems to work best in this area because of the volume needed. But the result and its persistence can not be compared to the relatively simple placement of a subfascial implant. Again, fillers here are more of a trial to determine if an implanted result is worth the effort.

Injectable fillers can also be used in the nose for limited amounts of reshaping. This has led to the concept of the ‘non-surgical rhinoplasty’. In truth, this moniker has a large marketing slant to it because fillers can not obviously replicate what a surgical rhinoplasty does.  But to temporarily mask an upper nasal bump, fill in some asymmetries or do a little tip lifting,  the judicious use of fillers can make some aesthetic nasal improvements.

Dr. Barry Eppley

Indianapolis, Indiana

The proven and effective method for buttock augmentation is through the use of soft flexible synthetic implants or fat injections. While each of these two approaches is not perfect and has their own advantages and disadvantages, they are safe medical therapies. But like in every other cosmetic procedure, patients do seek easier and less expensive methods that are not surgery to get more instant results. Buttock augmentation is no exception.

The past few years has seen the rise of non-surgical buttock augmentation procedures in the news, all using different non-medical filler materials. The recent arrest of Philadelphia’s Black Madam highlights this disturbing practice which is seen most commonly in major metropolitan areas and in susceptible African-American and Latino female populations. Some of these news reports have involved caulking compounds obtainable at the local hardware store which should suggest to even those most medically naïve that this would be problematic. But many other unreported buttock injection shops involve the use of silicone oil. On the surface this seems less risky but silicone oil is not FDA-approved for use as an injectable filler in the U.S. and its risk of granuloma, lumps and skin pigmentation changes are well known.

The use of any form of injectable filler for large volume body augmentation, such as the buttocks and breasts, is not under study in the U.S. Fat remains the gold standard for such uses even if it is far from yet perfected. But outside the U.S., other countries have been exploring and developing medical-grade fillers for body contouring. These materials are different formulations of those that are commonly used in the face, usually of the hyaluron-based family or hydrogel compounds.

Recognizeable by such names as Juvederm or Restylane, hydrogels are synthetically-created sugar-like compounds that are chemically similar to what our bodies already have and are very familiar. Thus they are well tolerated and is why they are more biocompatible than any collagen-based injectable filler to date. But their other interesting feature is that they attract water, hence the hydrogel name, and through this sponge-like effect is why they last as long as they do.

While the use of hydrogels for injectable buttock augmentation would seem to make sense, the sheer volume of material needed makes it too expensive. This expense combined with their short duration of effect has led to the development of more concentrated hydrogels. The higher the concentration of a hydrogel the longer it will last. Such international hydrogel materials like Aquamid are being tested but their long-term results and what side effects may exist as body fillers is not yet known.

No matter what is done in different countries, including the use of hydrogel injections, there is no good evidence of their effectiveness and safety. This certainly applied to silicone oil as well. Patients considering buttock augmentation should only consider what is medically proven and remember…you often do get what you pay for. There is no cheap and easy method to larger buttocks that is not fraught with significant risks of potentially unsolveable complications.

Dr. Barry Eppley

Indianapolis, Indiana

Valentine’s Day evokes many images, one of which is juicy full lips. While once only achievable by genetics, plumper and more full lips can be obtained by almost anyone thanks to a variety of  cosmetic procedures and products that are available today. Between celebrity news and photos, endless models in magazines and a plethora of  plumper and lipstick products,  lip augmentation has become one of the most sought after office procedures for women.

By far the most common method of lip augmentation is injectable fillers. While they are fairly quick and easy to do (notice I didn’t say completely painless), and effective for the majority of patients, they are several insights for a successful outcome and a satisfying experience.

While there are over a dozen commercially-available injectable filler products in the U.S., not all are appropriate for injection into the lip. The only ones that should be used are those composed of hyaluronic acid or hyaluron. These natural sugar products flow evenly and smoothly and have the less chance of causing  problematic nodules and lumps afterwards. Many such options exist (e.g., Juvederm, Restylanse) and the fundamental difference between them is how much they cost and how long do they last. Currently only Restylane is formally FDA-approved for use in lip augmentation but all other similar hyalurons can be safely used off-label. Though they may last lomger, avoid fillers that contain granules or crystals as they are more prone to foreign-body type reactions.

Not every lip can be made beautifully plump and full. As fillers work by expanding the size of the vermilion (pink part of the lip), one has to have enough of it to be expanded to create a fuller lip appearance. Very fine and thin lips simply can not be made two to three times their size to create a sensually full appearance. Trying to do so will make the vermilion expansion more horizontal than vertical, creating the classic and well recognized ‘duck lip’ appearance. Quite frankly, the most ideal and sensuous lip augmentation results occur in those women who already have what many people would consider good-sized lips. This doesn’t mean thin lips shouldn’t undergo a trial of lip injections to determine the results as some women will find the outcome acceptable. (anything is better than what I have concept) But if unsatisfactory results are obtained, it is time to consider surgical enhancement methods.

Lip injections are done by placing linear fills at either the vermilion-skin junction, into the body of the lip, or both. Most lips benefit by increasing the size of the white roll of the lips (vermilion-cutaneous junction) which creates a natural highlight. This is always good place to start. But size increase may also require direct vermilion body injection as well as augmenting the central pout of the vermilion or even the philtral columns of the skin of the upper lip. Good outcomes are a function of the skill and artistry of the injector as much, if not more, than the type of injectable filler product used. All lip augmentation results and injectors are not the same.

No matter how good a lip augmentation result can be, one will not be tempted to repeat it if the experience was uncomfortable. While there is no way to make lip injections pain-free, there are methods to make it more tolerable. Much is made today of some injectable fillers containing the local anesthetic lidocaine. While this does make the lip numb once it is injected with it, it is still necessary to get it in there in the first place. The choices are to either take a few injections directly into the lip to start to get it numb or to have a dental block done first. A recent innovation, known as a blunt-tipped cannula (e.g., Dermasculpt), is the best way in my opinion as it truly feels more comfortable than a beveled sharp needle of the same gauge (30 gauge) inside the lip.

Lip augmentation with fillers can have very a highly satisfying result and experience if one understands these basic concepts.

Dr. Barry Eppley

Indianapolis, Indiana   

The role of injectable fillers in facial rejuvenation and volume restoration continues to grow. With their growing acceptance and the number of patients requesting such facial treatments, it is no surprise that new options for injectable fillers continue to emerge. The majority of these continue to be hyaluronic-based fillers because of their biocompatibility, ease of injection, and very low risk of complications. 

Now adding to these hyaluronic-based fillers is Belotero. Earlier this week, Merz Aesthetics announced that the FDA has approved Belotero Balance for the correction of moderate-to-severe facial wrinkles and folds, specifically the nasolabial folds. Belotero is a hyaluronic acid-based gel that uses a cohesive polydensified matrix technology in its production. Its approval was based on results from a randomized, double-blind multicenter study of 118 patients. Based on these study results, the manufacturer claims that it has a lasting effect of 6 to 9 months and recommends two treatments per year to maintain the effects.

In a typical split-face design that all injectable filler prospects have used for FDA submission, the study patients received treatment with Belotero Balance filler on one side and a bovine collagen filler on the other side. Injections were into the nasolabial folds, the standard injection sites used for all FDA-approved injectable fillers. Patients were evaluated using a five-point Wrinkle Severity Scale (WSRS), ranging in severity from least (0) to most (4). Belotero Balance demonstrated greater reduction in the mean change of the WSRS at all time points and maintained more than 1 point WSRS reduction at 6 months (compared to 0.5 for the control).

Belotero has a significant prior history of use in Europe and the UK. Like many hyaluronic-based fillers today, it has different formulations intended for various types of facial uses. The Basic formulation (22.5mg/ml of NaHA) is intended for use in deep furrows, lip augmentation, facial outlines, nasolabial folds, glabellar lines and the correction of facial depressions. It is injected into the medium to deep dermis with a 27G needle. The Soft formulation (20mg/ml of NaHA) is used for superficial wrinkles such as perioral wrinkles, lip commissures, crow`s feet, and forehead wrinkles. It is injected into the upper dermis with a 30G needle. The Intense formulation (25.5mg/ml of NaHA) is for deeper lines and wrinkles. It is injected into the deep dermis with a 27G needle.

How does Belotero compare to the other hyaluronic-acid based fillers? It is impossible to say precisely but its composition and study results compare favorably to that of Juvederm. It is never a question of whether one type of injectable filler is better than another, it is a comparison of how long they last and their costs. The latter question with Belotero remains to be seen.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The benefits from exercise are tremendous and their merits become even more significant as we get older. We also live in a time when it is not uncommon for a 45 or 50 year person to run half-marathons. There are probably more than people, both men and women, that are avid runners and exercise addicts today than ever before. While America may be suffering increasing rates of obesity, there is also a growing number of exercise enthusiasts.

One interesting phenomenon that I have seen in middle-age runners is what has become known as the ‘runner’s face’ or exercise-induced facial atrophy. This can occur naturally in anyone that has always been thin and begins to show their age, but the mechanism of running can induce this visual loss of facial volume. You may say that as the body slims and one’s weight drops, the face can become drawn inward or more gaunt. This is the result of the face losing fat or volume with the cheeks turning inward and the frown lines becoming more pronounced. Facial wrinkles can also become exaggerated from the grimacing of the facial muscles with the exertion of aerobic exercise.

This unwanted change in one’s facial appearance seems an odd contrast to the other favorable effects that running has on the body. This is a unique affliction in my observation that strikes middle-aged runners in their forties and fifties. It is the result of exercise-induced fat loss, particularly that of the buccal fat pads which lie right below the cheek bones, which causes loss of support of the cheek, temple and perioral (lip) skin. This volume-loss skin contracture causes the face to look skeletonized or too gaunt. In severe cases, the eyes can even look sunken in and the temples concave. It can be most magnified in runners who were thin from their youth. When body fat percentages get below 8% to 10% in women and 10% to 12% in men, facial volume loss can be seen.

While sunscreen is the first line of defense for any runner, restoring facial volume and reducing wrinkles is the basis of a proactive approach. Injectable fillers are the backbone of effective facial volumizers. Well known injectable fillers, such as Juvederm and Restylane, induce facial fullness by adding a sponge-like sugar-based material known as hyaluronic acid or hyaluron. Similar to the fluid in one’s eyeball, their gel material consistency make them the easiest to inject with the least risk of lumps and irregularities. While none of them is permanent, their volume effects can last over half a year or longer depending upon how they are concentrated from the manufacturer. Other semi-permanent (Sculptra) and permanent fillers (Artefill) are also options that cost more but also last longer

Interestingly, the use of fat injections to the face is usually not a good idea for the runner. Besides the obvious likelihood that they may not have enough fat to harvest, the burning of calories from continued running makes fat injections last less than most of the synthetic injectable fillers.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Aging is inevitable and it begins to appear first around the eyes. With familiar names, such as crow’s feet, 11s, dark circles, bags and hooding, they indicate how visible and concerning these aging issues around the eyes can be. While surgical eyelid tucks and browlifts can offer dramatic improvements, many women and some men would prefer to try and prevent or even camouflage these eye flaws before considering surgery.

There is a progression of non-surgical treatments for keeping the eye area fresh and less old and tired looking. Known as periorbital (around the eye) rejuvenation, these include a variety of treatments combining neurotoxins, fillers, laser devices and topical products. These types of treatments usually follows the age of the person. Those in their 30s and 40s usually just need Botox to control the frowning and squinting. Fillers and light and laser treatments are added for those in the 40s and 50s. At 50 and beyond, only surgery can remove loose upper eyelid skin and lower eyelid bags. But these non-surgical treatments are still very useful to protect and maintain one’s surgical results.

Botox is the most recognizeable name when it comes to injectable wrinkle reduction since it was the first to be used. But it is no longer alone as two other injection drugs, Dysport and Xeomin, are now also available. While patients often believe that one of these is better than the other, they are all comparable in most cases. The differences between them is perceptual and not factual. They all take a few days to start working and will last in the range of three to four months. One is not more powerful than the others nor does one cost less. Because these injections are given by the unit, the cost per unit varies for each one but so does their effectiveness. (e.g., 1 unit of Botox equals 3 units of Dysport) As such their treatment costs are all about the same.

While Botox is the backbone of non-surgical eye treatments, injectable fillers can also play a role. Many people will develop shadowing and tear troughs under the lower eyelid, sometimes as early as the late 30s and early 40s. This can be treated with fillers placed to fill out them out. While they are over a dozen types of injectable fillers, the hyaluronic acid-based fillers (e.g., Restylane and Juvederm) are preferred as they can be delivered smoothly into the thin skin of the lower eyelids with minimal risk of lumps and irregularities.

While eye lines and wrinkles can be held in check with Botox and fillers, they can not reverse skin color and texture problems. Broken blood vessels and brown spots can be improved with high energy light therapies known as IPL or BBL. These are often confused with lasers which they are not. But when it comes to improving skin texture and reducing fine lines and wrinkles, laser resurfacing around the eyes can produce results that not even a formal eyelid lift can do.

Topical skin care products are important to help maintain the benefits of these injectable and energy treatments. The skin around the eyes is so thin that it responds well to many vitamin C, retinoid and antioxidant-containing products. A new topical product, Latisse, is great for thinning eyelashes and eyebrows and it works like nothing else. Having thicker eyelashes and eyebrows can really add to a more youthful look.

While surgery may be needed or inevitable for some, younger and less tired looking eyes may be just a few injections or the pass of a laser beam away.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The number of available injectable filler options has grown exponentially since the first non-collagen based products became available in 2002. Since then more than a dozen new variations of fillers has appeared, most of which are derivatives of hyaluron-based materials. All of these injectable materials have a limited duration of effectiveness because they are broken down and absorbed. The search for longer-lasting fillers is ongoing but has remained elusive to date.

There is great appeal in using filler materials extracted from the patient as it is both natural and may last much longer or even be permanent. Such has been the widespread use of liposuction-harvest fat but that is not as convenient as a more off-the-shelf product. In that vein, a company called Fibrocell Science has just received FDA approval for an injectible wrinkle treatment that uses a patient’s own cells.

According to the company and its product name, LaVív, it is an aesthetic cell therapy for improving the appearance of moderate-to-severe nasolabial folds in adults. The treatment uses a patient’s own fibroblasts which are extracted from a punch biopsy behind the ear. It is then sent to Fibrocell’s laboratory where the patient’s fibroblasts are grown and eventually returned to the physician for injection into the patient. The theory is that these transplanted fibroblasts will produce new collagen which will then fill and plump out the nasolabial fold. The entire process from harvest to treatment time is about 50 days. The fibroblast cultures are stored at the company so repeat injection material can be obtained for future treatments.

The clinical study submitted to the FDA for this autologous injection therapy was based on treatment results from human nasolabial folds being injected in three sessions spaced about six weeks apart. The results showed that a significantly greater number of patients had reduced nasolabial folds when injected with laVív than with a placebo. The patients were evaluated out to six months after the treatments.

While the FDA approval for this technology is recent, it is a older technique that was initially introduced over a decade ago. At that time, it was offered as a physician-ordered treatment that did not have FDA-approved status. I did several patients at that time and was using it in the treatment of depressed facial scars, specifically acne scars. It was my understanding that the company eventually decided to seek FDA approval for fear that growing and storing human cells would eventually come under the scrutiny of the FDA. This is now the fruit of a long effort at going through the FDA submission process.

In seeking FDA approval, it was logical to conduct the study for this autologous injection in the treatment of nasolabial folds. This is because every synthetic injectable filler that is commercially available is based on the use of nasolabial folds. This represents the easiest path for a study submitted to the FDA to gain approval. It can only be marketed as such but physicians no doubt will apply it to many other facial areas and aesthetic needs as well.

Does these fibroblast injections work? Do they grow, produce collagen, and last permanently? Is it better long-term that investing in temporary synthetic injectable fillers? These are the questions that widespread clinical use will eventually answer.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

The concept of injectable soft tissue fillers/augmentation has evolved dramatically over the past ten years. Besides the near continuous introduction of commercially-produced synthetic injectable fillers, using one’s own fat has also become mainstream. Although injectable fat grafting is far from perfect, it continues to become refined and more dependable.

Sometimes patients are understandably confused about the differences between these two injectable filler techniques. Because they both are injectable, it is not always easy for patients to see that they are not interchangeable and usually have very different indications for use. They differ in the areas of facial volume potential, technical complexity, treatment location, long-term rejuvenation effects, and cost.

One of the biggest differences between the synthetic and autogenous filling treatments is in how much volume that can be injected. Synthetic fillers come in syringes and are limited in volume ultimately by cost. Most patients get 1 or 2cc and, as such, small areas of augmentation like the lips and nasolabial folds are usually treated, keeping treatment costs anywhere between $ 300 to $ 1,200. Fat injections are not limited so much by cost and almost never by the patient’s donor sources. Larger volume areas are treated and include the face, breast, and buttocks. Costs are much higher, ranging from several thousand dollars and upward, but when compared by volume it is actually far ‘cheaper’ than synthetic fillers.

As a general rule, injection of the lips and nasolabial folds is best done by the synthetic fillers. In areas like deep creases, folds, wrinkles, and lines, all areas with a lot of facial muscle motion around them, fat doesn’t work well. Injectable fat is best used to contour the face by adding to volume deficient areas. It is not a good fold or wrinkle reducer.

Synthetic injectable fillers are almost always done in the office, require no preparation and their placement techniques are relatively simple. Avoiding lumpiness and having a smooth and even injection site is the end goal. Conversely, fat injections need to be done in more of an operating room setting, require significant preparation, processing and time, and a more skilled injection technique. Even though fat grafting is considered by many physicians to be similar to working with fillers, these procedures are definitely more complex.

Every known synthetic injectable filler used has a limited lifespan. Whether it be a few months or up to a year or longer, they all will eventually go away. There is also no real evidence that they can stimulate some permanent volume by collagen stimulation. Fat, however, can have some permanency and can even overgrow with time, something a synthetic filler can never do. Whether it is the survival of the fat cells or through the benefit of the stem cells that are carried with it that causes the injected fat volume to persist is not currently known. While not all injected fat survives, it always as the potential because of its cellular component. Hence, the rejuvenation potential with fat injections.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana